Researchers at the RCSI University of Medicine and Health Sciences appear to have made a breakthrough in pandemic-era diagnostics, with a new risk model published in The Lancet’s translational research journal, EBioMedicine.
The model, dubbed the Dublin-Boston score, employs mathematical measurements to help clinicians identify critical symptomatic COVID-19 cases early on. This will in turn expedite key interventions like steroids and injections.
“Patients with coronavirus disease 2019 (COVID-19) demonstrate elevated levels of circulating cytokines and accelerated progression to acute respiratory distress syndrome. As the burden of COVID-19 on healthcare resources grows, tools that help caregivers predict the clinical course of the COVID-19 patient address an area of need,” the authors wrote in the new paper. “Patients hospitalized for COVID-19 (n = 80) were selected at random from a list of medical record numbers corresponding to patients
with a confirmed diagnosis of COVID-19. Patients were excluded if they
were chronically immunosuppressed, receiving long-term oral corticosteroids, antivirals, hydroxychloroquine, anti-IL-1, anti-IL-6 or
anti-TNF therapy, known to be pregnant, on dialysis for chronic kidney disease, had active neoplasia, or had a history of vasculitis or connective tissue disease.”
A linear prognostic score to determine COVID-19 severity
Assessment begins with a blood test meant to detect levels of two distinct molecules: interleukin (IL)-6, which is a pro-inflammatory, and IL-10 which is an anti-inflammatory. Both are epicentral to the regulation of our autoimmune response and both are expressed irregularly high in severe COVID-19 patients.
“In this study, we evaluated longitudinal changes in IL-6
and the ratio of IL-6:IL-10 as they related to the clinical trajectory in 80
patients hospitalized for COVID-19. We aimed to determine whether
changes in IL-6:IL-10 ratio is superior to changes in IL-6 in identifying those at highest risk of clinical deterioration, and thus useful in
guiding clinical decision-making,” the authors continued.
By simply monitoring the ratio of these two molecules during the first four days of infection clinicians can predict how serious a COVID-19 case will be by the seventh day of infection. Predictive analysis can subsequently be applied to a COVID-19-specific point system.
Each one-point increase represents a 5.6 times increase for a more severe outcome.
“The Dublin-Boston score is easily calculated and can be applied to all hospitalized COVID-19 patients,” RCSI Professor of Medicine Gerry McElvaney, who also served as the study’s senior author and a consultant in Beaumont Hospital explained.
“More informed prognosis could help determine when to escalate or de-escalate care, a key component of the efficient allocation of resources during the current pandemic. The score may also have a role in evaluating whether new therapies designed to decrease inflammation in COVID-19 actually provide benefit.”
Recently Ladders covered the influx of COVID-19 patients enduring permanent health consequences because intervention occurred too late after exposure.
The Dublin Score will surely be subjected to further research before receiving the unanimous academic agreement, but most would agree that its introduction speaks well of the latest developments in pandemic containment.